CMS Sets Cap at $1,880 in Final Physician Fee Schedule Rule

The Centers for Medicare and Medicaid Services (CMS) released the final physician fee schedule rule for Calendar Year (CY) 2012, which sets the therapy cap on outpatient services (except outpatient hospital departments) at $1,880 beginning January 1, 2012. The therapy cap exceptions process will expire on December 31, 2011, unless Congress acts to extend it.

The final rule calls for a 27.4% cut in Medicare payments—less than the 29.5% cut estimated earlier this year—for physicians, physical therapists, and other health care professionals based on the flawed sustainable growth rate formula (SGR). However, if Congress intervenes before the January 1, 2012, effective date, the aggregate impact of work Relative Value Units (RVU), practice expense RVU, and malpractice RVU changes for 2012 on physical therapy services is a positive 4% (noted on Table 84 on page 1176 of the rule). According to CMS, the Obama administration is "committed to fixing the SGR and ensuring these payment cuts do not take effect."

CMS also will make changes in how it adjusts payment for geographic variation in the cost of practice. The agency is replacing some of the data sources—such as using data from the American Community Survey (ACS) in place of the Department of Housing and Urban Development (HUD) rental data and also using ACS data in place of the data currently used for non-physician employee compensation. CMS also will adjust its payments for the full range of occupations employed in physicians' office and will make other adjustments called for in prior year public comments.

The CY 2012 final rule also updates or modifies several physician incentive programs, including the Physician Quality Reporting System.

APTA will post a detailed summary of the final rule next week.

This article was updated November 4 to reflect when APTA's summary will be available.

Comments

It IS critical that Congress pass legislation before December 31, 2011 to extend the therapy cap exceptions process and to avoid the scheduled 29.5% cut in provider payments under the Medicare physician fee schedule.
Help us to help our patients!!!!!

Posted by Victoria Seff
on 11/2/2011 2:53 PM

It is critical that Congress pass legislation before December 31, 2011 to avoid the scheduled 29.5% cut in provider payments under the Medicare physician fee schedule. We are here to help our patients

Posted by Asha
on 11/2/2011 6:15 PM

These cuts are making Patient care very challenging and we need keep them FIRST in the process

Posted by Susanna Scully
on 11/2/2011 8:03 PM

It is imperative that this legislation be passed for the sake of our patients

Posted by Susan Leach
on 11/3/2011 7:39 PM

So, once again, NO cap on out-patient PT at a hospital. So where is private practice headed? Down the tubes????

Posted by Sue Jeffrey
on 11/4/2011 3:29 PM

I agree with Sue, why no cap on hospitals? I am really beginning to wonder whether private practice will exist in the next few years!

Posted by Mike Kriz
on 11/4/2011 5:03 PM

It's horrible to see health care heading in this direction. There are no cuts for other professions such as lawyers and pharmaceutical, but we who care for our patients are put to test every time. Congress for once needs to cut spending in other areas to deal with budget deficit and leave health care alone.

Posted by sapana Dixit
on 11/4/2011 5:17 PM

I've owned a private practice physical therapy clinic for 26 years, and during all of that time the cap has not applied to hospital outpatients. The only explaination my legislators have ever given me for the discrepancy is that the hospitals have bigger lobbying organizations.

Posted by Cindy
on 11/4/2011 7:31 PM

I have been in private practice for 10 years and every year reimbursement becomes more and more challenging. Of coarse, congress MUST put a stop to the threat of such a massive cut to Medicare beneficiary providers. This would have a huge impact on availability of services. Luckily this will affect the physicians also, so with the help of the AMA maybe it will be overturned. In addition, I'm wondering if we in private practice have another surprise awaiting for us as we did last year with MPPR. Why did we not hear anything about that before hand and what has the APTA done to get that overturned. Lastly, we might be able to manage a small decrease in reimbursement if there was not a one on one requirement for all services provided to MC beneficiaries. What has the APTA done to get this requirement reversed. It's ridiculous that we are now DPTs and get reimbursed less than my plumber or mechanic. WE NEED HELP or WE WILL NOT SURVIVE!!!

Posted by Jerry Yarborough
on 11/4/2011 8:48 PM

To accept payment for less than costs is not good business sense. Despite dedication to our patients, our doors would close if we cannot earn more than what it costs to pay bills. Please keep in mind that when deciding what Medicare reimbursement will be. Physical therapists cannot help their patients if their practicies are out of business.

Posted by Joan Firra
on 11/4/2011 9:00 PM

The people who dedicate there lives to educating themselves to provide Therapy do so to give there patients beck physical attributes that they have lost. We work hard and provide quality service to all regardless of race, creed and or color. We deserve to be reimbursed for the services that we provide.

Posted by Melissa Cruz
on 11/5/2011 3:17 PM

I don't know why or how the two different systems came about re: hospital and privatae practice reimbursement but I can tell you about the the defferent reporting systems. In a hospital setting there is an extra Medicare form in which you set out the specific functional goals, along with showing the medical necessity. If you do not meet goals, or the goals are too small in the eyes of the reviewer, then NO PAYMENT. This is on every paitent for every billing period, even the first few weeks. I was stunned to start working in a privatae practice and see long some of these patients came. I know that hospitals would not see them for tht long. I don't know anything about the dollar value of reimbursement, but I know of 2 hospital OP Departments that have closed their department or seriously cut back. Also don't forget that hospitals can't choose their patients based on reinbursement source, i.e. they have to see people with Medical or other lower paying insurance, which affects their income. Reimbursement in Hospital OP is a nightmare just as it everwhere else.

Posted by Beatrice Sims
on 11/5/2011 3:49 PM

Regarding the previous statement: I have seen just the opposite in the hospital OP settings. The OP hospital facilities are able to keep patients much longer, even without showing sigificant functional gains. I have had numerous medicare patients switch to our private practice from a hospital OP practice due to poor satisfaction only to become very frustrated that they are unable to come as often or long in the private practice setting. In addition, outpatient private practices are most definitely reviewed regularly and frequently to determine if functional gains are being made...not just with medicare, but with all insurances (and almost all require their own forms to be filled out). In my humble opinion, hospital OP physical therapy just takes us one step closer to socialized medicine and the government is pushing hard in that direction with cap and cuts to private practice.

Posted by Chris Z.
on 11/6/2011 9:57 PM

I have been in private practice for 28 years and it is quite obvious what is happening. Private practices across the country are being phased out by the government and insurance companies. ACOs, Physician Owned Practices, Foreign therapist influx for lower wages, Large Management Companies are just a few examples of how we are being attacked. The land of equal opportunity no longer prevails. We all know that the private sector of the American People can provide better services to our fellow man because we have a personal stake in what we do.

Posted by Arnold B.
on 11/8/2011 3:34 PM

I agre with Arnold. I avhe had now 40 years as a PT and see the hand-writing on the wall clearly. I see socialized medicine being phased in through the back door and private practice being for private pay clients only just as it is in every other socialized medicine nation. That means the best adn brightest will not likely enter medicine in any form...becasue of the limited return to pay for their education and because of the higher level of paperwork and lower standards of practice...I tried to do the PQRS but found my payment for the two years I did it was a measly $60 dollars! I would rather spend my time making patients better than trying to fill out forms to make them believe that I'm doing a good job.